| NPI | 1033139068 |
|---|---|
| Former Name | MARY ELIZABETH CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA Ap60852922) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A03326 ANP) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-03-19 |